Social Phobia

Social phobia is a disorder
characterized by overwhelming anxiety and excessive self-consciousness
in social situations. People with social phobia have a persistent, intense,
and chronic fear of being scrutinized by others and of being embarrassed
or humiliated by their own actions. Although it is common for many people
to experience some anxiety before or during a public appearance, anxiety
levels in people with social phobia can become so high that they begin
to avoid social situations. While many people with social phobia recognize
that the fear may be excessive or unreasonable, they are unable to overcome
it. In addition, they often worry for days or weeks in advance of a dreaded
situation.

Social phobia can be limited
to only one type of situation (such as a fear of speaking in formal or
informal situations, or eating, drinking, or writing in front of others)
or, in its most severe form, may be so broad that a person experiences
phobic symptoms in any social setting. Social phobia can be very debilitating
- people with this illness often avoid forming or maintaining close relationships
or they turn down chances to advance their careers. Some even become house-bound.

Physical symptoms often accompany
the intense anxiety of social phobia. People with social phobia experience
symptoms that include blushing, profuse sweating, trembling, and other
symptoms of anxiety, including difficulty talking and nausea or other
stomach discomfort. These visible symptoms heighten their fear of disapproval
in social settings and the symptoms themselves can become an additional
focus of fear. Fear of symptoms can create a vicious cycle: as people
with social phobia worry about experiencing the symptoms, the greater
their chances of developing the symptoms.

Social phobia often runs in families and may be accompanied by depression or alcoholism.

How Common Is Social Phobia?

At least 3.7% of the U.S. population (approximately 5.3 million Americans) has social phobia in a given year.

Social phobia occurs in women twice as often as in men, although a higher portion of men seek help for this particular disorder.

The disorder typically begins in childhood or early adolescence and rarely develops after age 25.

What Causes Social Phobia?

Research to define causes of social phobia is ongoing.

Some investigations implicate a small structure in the brain called the amygdala in the symptoms of
social phobia. The amygdala is believed to be a central site in the
brain that controls fear responses.

Animal studies are adding to the evidence that suggests social phobia can be inherited. In fact,
researchers supported by the National Institute of Mental Health (NIMH)
recently identified the site of a gene in mice that affects learned
fearfulness.

One line of research is investigating a biochemical basis for the disorder. Scientists are exploring
the idea that heightened sensitivity to disapproval may be physiologically
or hormonally based.

Other researchers are investigating the environment's influence on the development of social phobia. People
with social phobia may acquire their fear from observing the behavior
and consequences of others, a process called observational learning
or social modeling.

What Treatments Are Available for Social Phobia?

Research supported by NIMH and other institutions has shown that there are two effective forms of
treatment available for social phobia: certain medications and a specific
form of short-term psychotherapy called cognitive-behavioral therapy.
Medications include selective serotonin reuptake inhibitors (SSRIs), monoamine
oxidase inhibitors (MAOIs), and high-potency benzodiazepenes. Some people
with a form of social phobia called performance phobia have been helped
by beta-blockers more commonly used to control high blood pressure.

Cognitive-behavior therapy is also very useful in treating social phobia. The central component of
this treatment is exposure therapy, which involves helping patients gradually
become more comfortable with situations that frighten them. The exposure
process often involves three stages. The first involves introducing people
to the feared situation. The second level is to increase the risk for
disapproval in that situation so people build confidence that they can
handle rejection or criticism. The third and final stage involves teaching
people techniques to cope with disapproval. In this stage, people imagine
their worst fear and are encouraged to develop constructive responses
to their fear and perceived disapproval.

Cognitive-behavior therapy for social phobia also includes anxiety management training - for example,
teaching people techniques such as deep breathing to control their levels
of anxiety. Another important aspect of treatment is called cognitive
restructuring, which involves helping individuals identify their misjudgments
and develop more realistic expectations of the likelihood of danger in
social situations.

Supportive therapy such as group therapy, couples or family therapy to educate significant others
about the disorder is also helpful. Sometimes people with social phobia
also benefit from social skills training.

What Other Illnesses Co-Occur with Social Phobia?

Social phobia can cause lowered self-esteem, depression, and in extreme situations, suicide attempts.
To try to reduce their anxiety and alleviate depression, people with social
phobia may use alcohol or other drugs, which can lead to addiction.

Many people with social phobia may also develop other anxiety disorders. In particular, people with social
phobia may become so anxious that they experience panic attacks (intense
bursts of terror accompanied by physical symptoms) when in dreaded social
situations. As more situational panic attacks occur, people with social
phobia may take extreme measures to avoid situations in which they fear
another panic attack may occur or in which help may not be immediately
available.

This avoidance, similar to that in many panic disorder patients, may eventually develop into agoraphobia,
an inability to go beyond known and safe surroundings, because of intense
fear and anxiety.

Copyrighted and published by the Mental
Health America, no part of this document may be reproduced without written consent.